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SynopsisDiabetic nephropathy is a progressive kidney disease caused by vascular damage to the glomerular capillaries and arterioles as a consequence of long-standing hyperglycemia. Classically, this is characterized by progressive proteinuria followed by renal insufficiency. It can eventually lead to end-stage renal disease.
Patients with type 1 diabetes mellitus generally develop diabetic kidney disease within 10 years after diagnosis. There is more variability with diagnosis in patients with type 2 diabetes, as some people may never be affected and others lose renal function very quickly after diagnosis. Diabetic nephropathy is more common and more severe in African American and Latino populations. Aging, obesity, smoking, and poorly controlled hypertension are also risk factors for this condition.
Many physiologic factors are involved in the pathogenesis of this disease. Generally, chronic elevated serum glucose causes nonenzymatic glycosylation of the vasculature in the kidneys. Cytokines and other inflammatory markers have also been implicated in activating multiple pathways that contribute to glomerular damage over time. These mechanisms lead to hyaline arteriosclerosis, endothelial damage, and podocyte loss, which increase the glomerular filtration pressure and contribute to loss of proteins in the urine. This is a secondary cause of nephrotic syndrome.
E11.29 – Type 2 diabetes mellitus with other diabetic kidney complication
127013003 – Diabetic renal disease
Differential Diagnosis & PitfallsDiabetic nephropathy is a clinical diagnosis. Long-standing diabetes in the setting of progressive proteinuria or frank nephrotic syndrome supports the diagnosis of diabetic nephropathy. Alternative diagnoses to consider:
- Cystitis – Can present with increase urinary frequency or hematuria and is common in patients with diabetes.
- Minimal change disease – Common in children, idiopathic, normal glomeruli on renal biopsy.
- Focal segmental glomerulosclerosis – Usually idiopathic but there is a familial type as well, most common in African American and Latino populations, characteristic sclerosis and podocyte effacement on renal biopsy.
- Membranoproliferative glomerulonephritis – Commonly associated with hepatitis B and C, thickened glomerular membrane and immune complex deposition on renal biopsy.
- Systemic amyloidosis – Amyloid deposits on renal biopsy.
- Cryoglobulinemic glomerulonephritis – Presents with high serum cryoglobulins.
- Systemic lupus erythematosus nephritis
- Sjögren syndrome
- Erythema multiforme
- Congenital nephrotic syndrome – Finnish heritage and family history, disease presents in infancy and childhood.
- Fibronectin nephropathy – Family history, fibronectin positive on renal biopsy.
- Preeclampsia / HELLP syndrome – Pregnant patients with elevated blood pressure.
- Neoplastic process – Renal carcinoma, leukemia, melanoma, multiple myeloma.
- Infection – Including infective endocarditis, leprosy, syphilis, filariasis, malaria, schistosomiasis, Epstein-Barr virus, hepatitis B or C, herpes zoster, human immunodeficiency virus (HIV).
- Medication / drug side effect – History positive for use of drugs with renal side effects including some antivirals, cardiac glycosides, NSAIDs, lithium, interferon alpha, pamidronate, and heroin.
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.